1310 Canadian Family Physician•Le Médecin de famille canadien❖VOL 46: JUNE • JUIN 2000
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ompetence in computer services and med- ical informatics is seen as increasingly important for health professionals.1 Thus far, few family medicine programs in Canada or elsewhere provide adequate instruction in this area. Where such instruction exists, it generally lacks clear learning objectives and tends to be poorly integrated into general medical education. While many family medicine programs are slow to offer res- idents a coherent informatics curriculum, most resi- dents want more computer and informatics training and think it should be a mandator y component of family medicine programs.2
A study of first-year residents in all Canadian university-affiliated family medicine residency pro- grams during the 1993-1994 academic year found that only 13% of respondents felt extremely or ver y comfortable with using computers. The most com- monly cited barriers to obtaining computer training were lack of time and the high cost of computers, but not lack of interest. Residents were willing to have computer instruction included in their resi- dency training (71%), and about half of respondents (46%) were willing to be evaluated on their skills.
They thought the type of computer training most useful to them would include word processing (65%), database searching (64%), of fice billing (61%), and office management (50%).2
To facilitate the development and implementation of a fully integrated medical informatics and computer services curriculum in our program, we decided to assess how much family practice educators in the
Depar tment of Family Medicine at McMaster University were using computers and medical infor- matics in routine clinical practice and teaching. In spring 1998, we mailed a survey to all family practice teaching staff (33 preceptors in three academic family practice units and 16 community family physician pre- ceptors) asking about their routine use of computers and teaching about computers to family medicine resi- dents. Of 49 questionnaires mailed out, 47 usable ones were returned for a final response rate of 96%.
Respondents included 34 physicians, nine nurses and nurse practitioners, and four social workers.
The questionnaire collected sociodemographic characteristics, self-reported computer use and knowl- edge, and adequacy of currently available computer hardware and software and listed 12 commonly used computer applications. For each application, respon- dents were asked to indicate whether it was available in their practices. Each of the 12 applications or tools was then rated on a 7-point Likert-type scale in terms of frequency of use as part of routine clinical practice, frequency of teaching about it as part of routine teach- ing, perceived improvement in clinical practice associ- ated with use of each application, and interest in developing more skill in each area.
Most respondents (82.2%, 37/45) reported they personally used a computer at work, and the overall mean for self-assessed computer knowledge was 3.7 on the 7-point scale (standard deviation [SD] 1.6). The overall mean rating for perceived adequacy of current- ly available computer hardware and software was 4.6 (SD 1.7). Nine of the 12 applications surveyed were available to more than 50% of preceptors. Three appli- cations (appointments, billing, and e-mail) were avail- able most frequently, with mean scores higher than 4.5. Reported mean scores for teaching computer- based tools and applications to residents were low, except for appointment software, with a mean of 5.9.
Preceptors viewed appointment software as improving their routine practice (mean 4.4), but all
Short report: Medical informatics
How do family medicine educators at McMaster University use it and teach it?
Janusz Kaczorowski, MA, PHD Allyn Walsh, MD, CCFP, FCFP David H. Chan, MD, CCFP, MSC Kristina Trim, MA
C
Drs Kaczorowski, Walsh, and Chan teach, and Ms Trim is a research assistant, in the Department of Family Medicine at McMaster University in Hamilton, Ont.
This article has been peer reviewed.
Cet article a fait l’objet d’une évaluation externe.
Can Fam Physician2000;46:1310-1312.
RESEARCH
Short report: Medical informatics
VOL 46: JUNE • JUIN 2000❖Canadian Family Physician•Le Médecin de famille canadien 1311 NO. WHO HAD
IT AVAILABLE (%)
ROUTINE USE, MEAN SCORE (SD)
ROUTINE TEACHING, MEAN SCORE (SD)
IMPROVES PRACTICE, MEAN SCORE (SD)
FURTHER TRAINING DESIRED, MEAN SCORE (SD)
E-mail 44 (94) 4.9 (2.3) 3.0 (2.1) 3.3 (1.9) 3.6 (2.0)
MEDLINE
searching 36 (77) 3.5 (2.1) 2.8 (2.1) 3.9 (2.2) 4.5 (1.9)
Other internet
resources 34 (72) 3.0 (1.8) 2.4 (1.7) 3.3 (1.9) 5.0 (1.7)
Internet discus- sion and mailing groups
25 (53) 2.0 (1.6) 1.5 (1.0) 2.1 (1.3) 3.4 (2.1)
Searchable reference systems
28 (60) 2.8 (1.9) 2.5 (1.9) 3.2 (2.1) 4.4 (2.2)
Word processing 42 (89) 3.8 (2.3) 1.6 (1.0) 3.1 (2.4) 3.4 (2.0)
Presentation
software 13 (28) 2.4 (2.0) 1.4 (1.0) 2.1 (1.7) 4.2 (2.1)
Spreadsheet and
database software 24 (51) 2.6 (1.9) 1.6 (1.1) 2.3 (1.8) 3.5 (2.1)
Statistical
software 19 (40) 1.7 (1.2) 1.5 (1.2) 1.9 (1.4) 3.8 (2.1)
Billing software 32 (68) 4.3 (2.9) 2.6 (2.0) 3.4 (2.3) 2.5 (1.9)
Appointment
software 42 (89) 5.9 (2.0) 4.1 (2.2) 4.4 (2.2) 3.1 (2.1)
Electronic
patient records 16 (34) 2.3 (2.1) 2.5 (2.1) 2.4 (2.1) 4.5 (2.1)
Table 1.Availability, routine use, routine teaching, perceived improvement in practice associated with, and interest in, further training for 12 computer applications assessed on a 7-point Likert-type scale
other applications were rated as relatively unlikely to improve their practice, with reported means of lower than 4. In contrast, interest in receiving further train- ing was relatively low for appointment and billing software but considerably higher for Internet-based ser vices, presentation software, and electronic patient records (Table 1).
As other researchers have found, preceptors’ use of computers appears to be based on their perceived usefulness in meeting daily work requirements.
Applications that have a direct, daily relevance were described as most used and, consequently, most taught to residents. These included appointment and billing software, and e-mail. Because these applica- tions were most familiar and widely available, little interest was reported in learning more about them.
Preceptors, however, expressed a high degree of interest in learning about relatively “newer” applica- tions, such as Internet resources (including MED- LINE), electronic patient records, searchable CD-ROMs, and presentation software.
Overall, preceptors reported that they infrequently taught computer skills to residents. The most frequently taught computer application was appointment software, but the mean score for this was 4.1. Other applications had mean scores lower than 3 on the 7-point scale. As
expected, preceptors’ own routine use of specific com- puter tools and applications tended to overlap with the frequency of teaching these applications to residents.
This finding, along with the relatively high interest in further developing skills in most of the areas sur- veyed, suggests that successful implementation of a medical informatics and computer services curricu- lum should start with faculty development and follow with the “seamless” integration of informatics as an integral part of the family medicine residency cur- riculum. Because computer competence is becoming essential for practising family physicians, family med- icine educators should be urgently concerned about teaching it effectively and integrating informatics into their curriculums.
Correspondence to: Janusz Kaczorowski, Assistant Professor, Depar tment of Family Medicine, Faculty of Health Sciences, McMaster University, 1200 Main St W, Hamilton, ON L8N 3Z5; telephone (905) 521-2100, extension 76198; fax (905) 528-5337; e-mail kaczorow@
fhs.McMaster.ca
References
1. Cameron S. Toward a national curriculum in informatics.
Can Fam Physician1998;44:2044-6 (Eng), 1998;44:2053-6 (Fr).
2. Rowe B, Ryan D, Therrien S, Mulloy J. First-year family med- icine residents’ user of computers: knowledge, skills and atti- tudes. Can Med Assoc J 1995;153(3):267-72.
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Short report: Medical informatics
1312 Canadian Family Physician•Le Médecin de famille canadien❖VOL 46: JUNE • JUIN 2000
Key points
• This survey of McMaster University family medi- cine educators found computers were used most frequently for word processing, billing, e-mail, and making appointments.
• Highest interest in learning new informatics skills was for Internet resources, searching MEDLINE, electronic patient records, searchable CD-ROMS, and presentation software.
Points de repère
• Ce sondage auprès des enseignants en médecine familiale de la McMaster University a révélé que les ordinateurs étaient le plus fréquemment utili- sés pour le traitement de textes, la facturation, les courriels et les rendez-vous.
• En ce qui avait trait à l’apprentissage de nouvelles compétences en informatique, on s’intéressait sur- tout aux ressources sur Internet, à la recherche dans MEDLINE, aux dossiers électroniques des patients, aux cédéroms consultables et aux logi- ciels de présentation.
